To celebrate February as American Heart Month, the News Blog is
highlighting some of the latest heart-centric news and stories from all areas
of Penn Medicine.

At first pass, lariat seems like just a hifalutin' word
for the more down-to-earth, lasso – a
long, noosed rope. For most, either word will bring to mind images of cowboys
and rodeos, not human hearts. However, thanks to a new technology making its way
onto the medical scene, lariat has a new meaning and is helping to treat the
most common of cardiac arrhythmias, atrial fibrillation.

Let’s take a few steps back
though, before we make the leap from rodeo ring to hospital.

New Heart Procedure to Treat Atrial Fibrillation Atrial fibrillation (AFib) is an
irregular heartbeat that feels like a fluttering or quivering of the heart that
affects close to three million Americans. According to the National Heart, Lung
and Blood Institute, when AFib occurs, rapid, disorganized electrical signals cause
the heart’s two upper chambers to fibrillate, or contract very quickly and
irregularly.

AFib causes blood to pool in the
upper chambers of the heart. This keeps the heart from pumping blood completely
into the heart’s two lower chambers. While for some, the symptoms of AFib can feel
very frightening, others have no signs at all. But symptomatic or not, make no
mistake about it: AFib is not a simple “heart flutter” and certainly not
something to ignore. The biggest threat from atrial fibrillation is the threat
of blood clots and stroke.

“Patients with atrial
fibrillation are six times more at risk of having a stroke and 15 to 20 percent
of all strokes a year are related to AFib,” said Daniel J. McCormick, DO, FACC, FSCAI, an interventional
cardiologist
at Pennsylvania Hospital. “This is not only
significant from a direct health care standpoint, but a societal one as well since
stroke is one of the biggest drivers of disability and health care costs in the
U.S.”

The standard treatment for
AFib is the use of anticoagulants, more commonly known as blood thinners, such
as warfarin, and heparin. While there will always be a need for blood thinners in
medicine, the truth is, their effectiveness is precisely what makes them so
dangerous. Warfarin, the most commonly used for example, is also used to poison
rats and mice. Its anti-clotting properties produce death through internal
hemorrhaging – a trait you want to control rodent populations, not your AFib.

This is why warfarin is
considered a “black box drug” by the U.S. Food and Drug Administration (FDA).
The black box is the strictest warning the FDA can give a medicine while still
permitting it to remain on the market. According to Dr. McCormick, patients on
blood thinners must be monitored weekly to make sure their medication levels
are safe, which limits one’s mobility and quality of life. Striking a balance
between effective, therapeutic levels of blood thinners and hazardous ones is
delicate and requires constant diligence on part of both the patient and
physician – a level of diligence many patients aren’t capable of maintaining.
“Even with careful monitoring only about 20 percent of all patients on warfarin
are within the proper range at any one given time,” explained Dr. McCormick.
“These patients are living on a very short leash.”

According to McCormick, herein
lies a primary challenge of treating patients with AFib: there is a real need for other therapies to
treat patients that:

1)
Have a prior history of stroke and can’t take anti-coagulants
because of bleeding complications.

2)
Are extremely difficult to manage despite diligence and
monitoring.

More invasive treatments for
AFib include implants (currently still in clinical trials) and surgery to place
sutures, clips and staples to close off the affected trouble areas of the
heart.

A little less invasive in that
it doesn’t leave anything in the heart, is radiofrequency
ablation, where a small, flexible catheter is inserted through a vessel in
the groin and up to the heart. Using fluoroscopy, a live x-ray image, an
interventional cardiologist carefully guides the catheter up into the heart where
small electrodes are placed. The electrodes, connected to monitors to help
locate what exact areas of the heart are causing the AFib, are also used to
send electrical energy to the problem areas, effectively destroying them and
creating a tiny bit of scar tissue. It’s the scarring that halts the irregular
heart rhythm. While ablation can often control AFib and many patients do well,
it’s not full-proof. “There’s a high recurrence rate of AFib in ablation
patients – about 30 percent,” said Dr. McCormick.

Enter the lasso! Or more
specifically, PLACE™ a LARIAT®. By using the PLACE procedure of Permanent Ligation
Approximation Closure and Exclusion, a physician is able deploy the LARIAT, an
FDA-approved Left Atrial Appendage Occlusion Device, to seal off the
malfunctioning area of the heart where dangerous blood clots can form.

Dr. McCormick performed the
first two LARIAT cases on January 30, at Pennsylvania Hospital, the first in
the region to use the new technology and second in the state.

Performed in the hospital’s cardiac
catheterization lab, the procedure takes approximately two hours with a patient
under general anesthesia. Two small catheters are threaded through the groin up
to the heart allowing for two magnetic tipped wires to hold the affected area
in place. Then a balloon is inflated to confirm the proper position of the area
to be sutured off with a micro-mini lasso. The suture/lasso/lariat is then cinched
up around the base of the appendage, sealing off the problem area. After a
year, the whole affected area just naturally withers away to nothing. While
still in the early stages of employment, previous use so far suggests there are
low complications and a high success rate associated with the procedure.

Patients are required to stay on bed rest
for four hours once out of recovery and stay over the night in the hospital.
“The LARIAT provides a permanent solution for stroke risk associated with atrial
fibrillation without leaving any devices or other objects behind in the heart.”
said McCormick. “But what’s really exciting is that the patient is off warfarin
immediately after the procedure. It’s terrific to be able to add another tool
to our arsenal of treatments for atrial fibrillation.

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This blog is written and produced by Penn Medicine's Department of Communications.

Views expressed are those of the author or other attributed individual and do not necessarily represent the official opinion of the related Department(s), University of Pennsylvania Health System (Penn Medicine), or the University of Pennsylvania, unless explicitly stated with the authority to do so.

Health information is provided for educational purposes and should not be used as a source of personal medical advice.